Utilization Review RN: Acute Care & MedNec Expert

University of Texas Southwestern Medical Center; Dallas (TX); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

PPO medical plan

Paid Time Off

Retirement Programs (TRS)

Paid Parental Leave

Wellness programs

Tuition Reimbursement

Public Service Loan Forgiveness (PSLF)

Job summary

UT Southwestern Medical Center is seeking an experienced Utilization Review RN to conduct medical certification reviews for acute care. Youill assess level of care using evidence-based guidelines and collaborate with physicians and staff to ensure appropriate utilization and documentation.

The role requires an active Texas RN license, a strong background in utilization management, and experience with Epic CCM.

Qualifications

• Graduate of an accredited nursing program with an active Texas RN license.
• 5 years of experience including 2 years in clinical settings plus 3 years in utilization review.
• Prior experience with Epic CCM.

Responsibilities

• Collaborates with the Central Scheduling Department to obtain accurate clinical information for authorization.
• Conducts admission reviews for Medicare/Medicaid and private insurance using evidence-based guidelines.
• Communicates with admitting physicians when documentation does not support the level of care.
• Uses hospital-approved medical necessity tools to determine inpatient or observation level of care.
• Keeps current on federal, state and local regulatory changes affecting delivery and reimbursement.

Skills

Utilization review

Clinical experience

Education

RN license Texas

Nursing degree

Tools

Epic CCM

Job description

UT Southwestern Medical Center is seeking an experienced Utilization Review RN to conduct medical certification reviews for acute care. Youill assess level of care using evidence-based guidelines and collaborate with physicians and staff to ensure appropriate utilization and documentation.

The role requires an active Texas RN license, a strong background in utilization management, and experience with Epic CCM.